22 U.S.C. § 7611 — Development of a comprehensive, five-year, global strategy

(a) Strategy: The President must create one comprehensive, integrated 5-year strategy to expand and improve the U.S. fight against global HIV/AIDS^*. The strategy must do the following:

(1) Strengthen U.S. leadership in the global fight, and strengthen the ability of affected nations to fight the disease themselves.
(2) Stay flexible enough to respond to changes in the epidemic, challenges partner countries face, and new evidence-based improvements in prevention, care, and treatment.
(3) Fit U.S. HIV^*/AIDS^*, tuberculosis, and malaria efforts into the country's broader global health and development work, linking disease-specific spending to strengthening health systems, and coordinating these programs with other health and development programs.
(4) Include a plan to: (A) prevent 12,000,000 new HIV infections worldwide; (B) increase the number of people getting antiretroviral treatment beyond earlier goals, including through joint international efforts; (C) support care for 12,000,000 people infected with or affected by HIV/AIDS, including 5,000,000 orphans and vulnerable children, through coordinated services; (D) help partner countries reach 80 percent access to counseling, testing, and treatment that prevents mother-to-child transmission; (E) help partner countries give HIV-positive children care in proportion to their share of the HIV-infected population; (F) promote training for health workers to fight HIV/AIDS, tuberculosis, and malaria; (G) give teachers the skills to prevent HIV/AIDS and support affected people; (H) share best practices with health professionals; (I) promote pediatric HIV/AIDS training for doctors, nurses, and other health workers, including through public-private partnerships and possible "centers of excellence"; and (J) help train and keep at least 140,000 new health care professionals and paraprofessionals, with a focus on doctors and nurses in places like sub-Saharan Africa, aiming for the World Health Organization's target of 2.3 doctors, nurses, and midwives per 1,000 people.
(5) Use approaches across many sectors to treat and prevent HIV, focusing especially on families with children, women, young people, orphans, and vulnerable children.
(6) Set a timetable with yearly global treatment targets and country-level benchmarks.
(7) Expand the use of timely, relevant research in HIV/AIDS prevention, care, and treatment.
(8) Include a plan to monitor programs, study how they operate, evaluate their impact, and share a best-practices report.
(9) Support training — ideally through public-private partnerships — of local and regional scientists, managers, and staff who can turn research findings into everyday practice, to improve HIV/AIDS care.
(10) Expand and speed up research into HIV prevention methods for women, including more collaboration and resources for microbicide research.
(11) Consult local leaders and officials to build prevention strategies fit to each country and community, targeting people most at risk.
(12) Make reducing risky behavior a top prevention priority, by: (A) promoting abstinence, monogamy, and faithfulness; (B) encouraging correct, consistent condom use and better access to condoms; (C) promoting later first sexual activity and fewer concurrent partners; (D) educating "discordant couples" (where one partner has HIV and the other does not, or does not know) about safer sex; (E) promoting counseling, testing, and treatment for people who inject drugs or use other substances; (F) educating men and boys about the risks of paying for sex and about ending violence toward women and girls; (G) helping partner countries and communities identify and address social, economic, or cultural factors, such as migration, urbanization, conflict, gender-based violence, lack of empowerment for women, and transportation patterns, that directly contribute to HIV transmission; (H) supporting comprehensive programs that promote alternative livelihoods, safety strategies, and social reintegration strategies for commercial sex workers and their families; (I) supporting law enforcement in prosecuting trafficking, rape, and sexual assault; and (J) working to end rape, gender-based violence, sexual assault, and sexual exploitation of women and children.
(13) Include programs that address the particular HIV risks women and girls face.
(14) Support other prevention methods, including: (A) medical male circumcision; (B) keeping the blood supply safe; (C) promoting universal precautions in health care; (D) educating the public about HIV risk from blood exposure in health care and cosmetic services; (E) investigating suspected hospital-acquired infections to stop further spread; and (F) other ways to reduce transmission.
(15) Increase support for preventing mother-to-child transmission.
(16) Build public health capacity in developing countries by strengthening health systems and infrastructure, and by developing ways to measure progress.
(17) Better coordinate HIV/AIDS programs with development programs generally.
(18) Provide a framework for growing or creating country or regional programs, including drafting agreements, setting criteria and goals for them, and promoting sustainability.
(19) Provide a plan for national and regional funding priorities and a global investment plan by region.
(20) Provide a plan for the needs of women and girls that: (A) addresses what makes them more vulnerable to HIV; (B) sets specific goals and targets; (C) gives field staff clear guidance to build gender considerations into programs; (D) sets gender-specific ways to track progress; (E) supports passing and enforcing inheritance-rights laws where women or orphans lack them; (F) supports life-skills training for women and girls; (G) addresses and prevents gender-based violence; and (H) addresses the trauma of gender-based violence and rape, and provides post-exposure HIV prevention to victims.
(21) Provide a plan to: (A) find local factors that put men and boys at higher HIV risk; (B) address male behaviors that raise that risk, including cutting alcohol abuse; (C) promote responsible male behavior; and (D) promote male involvement and leadership in HIV prevention, reducing stigma, testing, and care.
(22) Provide a plan for the needs of orphans and vulnerable children.
(23) Encourage partner countries to build training programs for people leaving orphan and vulnerable-children programs.
(24) Provide a framework to work with international partners toward universal access to HIV prevention, treatment, and care, with prevention as a special priority.
(25) Improve coordination of U.S. bilateral efforts with other major public and private organizations.
(26) Give more attention to partner countries' own national HIV/AIDS strategies by reviewing decisions tied to U.S. assistance and helping strengthen those strategies where needed.
(27) Support the Global Plan to Stop TB, including expanding directly-observed short-course treatment (DOTS) for people with both tuberculosis and HIV (including drug-resistant TB), and improving coordination between HIV and TB programs.
(28) Coordinate between the Global AIDS Coordinator^* and the Malaria Coordinator, addressing overlap between HIV/AIDS and malaria.
(29) Include a longer-term estimate of resources needed, progress toward country ownership, and the expected U.S. role over the 10 years starting October 1, 2013.

(b) Report: (1) In general: By October 1, 2009, the President must send Congress a report laying out the strategy from subsection (a).
(2) Contents: That report must discuss, among other things: (A) the strategy's purpose, scope, methods, and goals; (B) problems, risks, and threats to carrying it out; (C) its goals, activities, and how success will be measured; (D) future costs and resources needed; (E) which parts of the U.S. government are responsible for what, and how they will coordinate; (F) how the strategy will align U.S. aid with other international, national, and private efforts (the "Three Ones"), and how it will handle challenges doing so; (G) how the strategy supports partner countries' own national HIV/AIDS plans and makes them more central, effective, and sustainable; (H) how the strategy will meet the targets in subsection (a) and other targets; (I) the treatment-target timetable, country-level estimates of treatment need, and U.S. support benchmarks — plus, if global targets are missed, a plan to fix that and a breakdown of spending where targets are missed; (J) how research on programs is built into the strategy, to improve quality, check cost-effectiveness, ensure accountability, measure population impact, share findings, and improve service delivery; (K) an analysis of U.S.-backed prevention strategies (abstinence, monogamy, faithfulness, condom use, fewer partners, delayed sexual activity) and how their effectiveness will be tracked; (L) within that analysis, other prevention tools such as male circumcision, safe blood supply, public education, universal precautions, and investigating hospital-acquired infections; (M) efforts to address root social, economic, and cultural causes of HIV spread in partner countries; (N) specific strategies for women's and girls' needs, including activities for men and boys, education and livelihood opportunities, legal empowerment, anti-violence programs, adolescent-specific strategies, help for victims of violence and trafficking, and alcohol-abuse prevention; (O) strategies addressing male norms and behavior, promoting responsible male behavior and male leadership in HIV programs; (P) strategies for orphans and vulnerable children, including what makes them vulnerable and how communities help decide who participates; (Q) a description of partner countries' own capacity-building, including under the Abuja Declaration, and how International Monetary Fund economic policy affects health investment; (R) a strategy to build public health capacity, improve health care, help countries develop health-workforce plans, meet staffing and retention goals, promote ethical recruiting, and increase program sustainability; (S) the criteria, goals, and structure for country or regional compacts, including civil society's role, transparency, success benchmarks, and how compacts relate to partner countries' own strategies; (T) a strategy to better coordinate HIV/AIDS aid with nutrition and food assistance; (U) a description of regional efforts against concentrated epidemics, such as in the Caribbean; (V) planned resource distribution and investment by region; (W) coordination to implement the Stop TB Strategy and address HIV-TB coinfection, including projected challenges or barriers to successfully implementing the strategy; and (X) coordination to address malaria and HIV-malaria comorbidity.

(c) Study of progress toward achievement of policy objectives: (1) Design and budget plan for data evaluation: Within 18 months after July 30, 2008, the Global AIDS Coordinator must contract with the Institute of Medicine of the National Academies, under a contract requiring the Institute, in consultation with the Global AIDS Coordinator and other relevant public- and private-sector representatives, to provide a design plan and budget for evaluating and collecting baseline and later data on the topics in paragraph (2)(B), and must send that plan and budget to Congress.
(2)(A) Within 4 years after July 30, 2008, the Institute of Medicine must publish a study assessing U.S.-funded global HIV/AIDS programs' performance and the health impact of U.S.-funded prevention, treatment, and care efforts, including joint programs.
(B) That study must cover: (i) progress toward prevention, treatment, and care targets; (ii) effects on health systems, financing, management, and service quality; (iii) efforts to address gender-specific aspects of HIV/AIDS, including gender-related constraints on accessing services and underlying social and economic vulnerabilities of women and men; (iv) the impact of treatment programs on 5-year survival, drug adherence, and drug resistance; (v) the impact of prevention programs on new HIV cases; (vi) the impact on child health and welfare from orphan and vulnerable-children programs; (vii) the impact on child mortality; and (viii) recommendations to improve the programs.
(C) The study must use sound statistical and behavioral-science methods, including random assignment where feasible, and qualitative data where possible.
(3) The Institute of Medicine can contract, use cooperative agreements, or award grants to carry out this study.
(4) Congress may appropriate whatever funds are needed for this study.

(d) Comptroller General report: (1) Within 3 years after July 30, 2008, the Comptroller General must send Congress a report on U.S. global HIV/AIDS programs.
(2) That report must cover: (A) how these programs are monitored and evaluated; (B) how well federal agencies coordinate internally and with the broader U.S. global health agenda; (C) how procurement is handled; (D) how well U.S. efforts align with partner countries' own strategies and other international efforts; (E) how global HIV/AIDS funding affects other U.S. global health programs; and (F) recommendations to improve these programs.

(e) Best practices report: (1) Within 1 year after July 30, 2008, and every year after that, the Global AIDS Coordinator must publish a report highlighting U.S.-funded programs worth copying elsewhere, especially low-cost ones, across both widespread and localized epidemics.
(2)(A) The Coordinator must post the full report on the Office of the Global AIDS Coordinator's website.
(B) The Coordinator must create guidance to make sure best-practices information is shared promptly.

(f) Inspectors General: (1)(A) The Inspectors General of the State Department and Broadcasting Board of Governors, Health and Human Services, and USAID must jointly write yearly oversight plans for each fiscal year from 2009 through March 25 of fiscal year 2025, covering programs under this chapter and related sections.
(B) Each plan must schedule financial audits, inspections, and performance reviews.
(C) Deadlines: (i) the first plan is due by September 1, 2008, or 60 days after July 30, 2008, whichever is later; (ii) plans for 2010 through 2013 are due 30 days before each of those fiscal years; (iii) the 2014 plan is due 60 days after December 2, 2013; and (iv) plans for 2015 through 2025 are due 30 days before each of those fiscal years.
(2) To avoid duplicating work, these Inspectors General must coordinate with the Government Accountability Office and, as appropriate, the Inspectors General of Commerce, Defense, Labor, and the Peace Corps, under a 2004 interagency agreement (or its successor).
(3) The Global AIDS Coordinator and the Malaria Coordinator must give these Inspectors General up to $15,000,000 total over the 5 years starting October 1, 2008, to pay for these audits, inspections, and reviews.

(g) Annual study: (1) By September 30, 2009, and every year after through March 25, 2025, the Global AIDS Coordinator must complete a study of treatment providers that: (A) represents a range of countries and settings; (B) estimates the per-patient cost of antiretroviral treatment and of care for people not on antiretrovirals, comparing costs to similar non-U.S.-funded programs; and (C) breaks down per-patient costs by category, including urban vs. rural, by country, and other relevant subgroups.
(2) Starting with the study due September 30, 2014, and each year after through March 25, 2025, studies must also include: (A) a plan for cost studies of assistance under section 2151b–2 in partner countries, weighing better data collection against limited resources; and (B) a combined spending analysis by partner country, comparing U.S., Global Fund^*, and national spending where possible — or, where that comparison is not yet practical, an explanation why and when it will be.
(3) Within 90 days after finishing each study, the Coordinator must post the results on a public website.
(4) "Partner country" means a country that got at least $5,000,000 in U.S. HIV/AIDS assistance the prior fiscal year.

(h) Message: The Global AIDS Coordinator must create a message, to be prominently shown by every program funded under this chapter, that: (1) shows the program as a commitment by U.S. citizens to the global fight against HIV/AIDS, tuberculosis, and malaria; and (2) helps program recipients understand the program as an effort made on behalf of the American people.